10例脾脏囊型包虫病临床诊治分析

发布时间：2018-02-14 19:51

本文关键词： 脾脏囊型包虫继发性临床特点诊断治疗　出处：《石河子大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨脾脏囊型包虫病的临床特点,提高临床诊治水平。方法:回顾性分析2007年1月至2016年1月我院收治的经外科手术治疗10例确诊为脾脏囊型包虫病患者的临床资料。果:10例患者均长期生活于囊型包虫病流行区(中国新疆),均有犬羊密切接触史;10例SHC患者中8例既往有囊型包虫病手术史(1次或多次),2例既往无外伤手术史。10例患者中最常见的首发症状为腹痛、腹胀等其它腹部脏器受包虫所累产生的相应症状,查体多未触及脾脏肿大。实验室检查无特殊,影像学检查提示肝、脾等腹腔多脏器多发囊性占位,部分脏器影像表现为典型囊型包虫病特征。5例患者行“脾包虫内囊摘除+其它部位包虫摘除术”,4例患者因脾脏多发包虫且累及脾门行“脾切除+其它部位包虫摘除术”,1例患者脾脏包虫囊肿小且有大量钙化坏死征像而未行手术治疗,仅行“其它部位包虫摘除术”,10例患者术后均预防性口服阿苯达唑3个月-半年。1例脾包虫合并门脉高压患者行“脾切除+其它部位包虫摘除术”术后患者血小板计数持续维持在正常参考值上限及发生双侧少量胸腔积液,1例术后出现粘连性肠梗阻,2例患者术后发生双侧少量胸腔积液,其余6例无早期术后并发症发生。随访1-3年,患者均未见脾脏包虫再发,预后良好。结论:1.脾脏囊型包虫病患病率低,除脾脏受累外,同时多合并其它脏器包虫。2.有包虫病史再发脾脏包虫者多为继发性脾脏包虫病患者。3.继发性脾脏囊型包虫病临床表现缺乏特异性,常规血清检测对临床确诊无特异性意义,初步诊断可结合脾脏或其它部位典型包虫囊肿影像及病史,确诊需术后病理。4.继发性脾包虫临床以开腹手术联合术后驱虫治疗为宜,可降低再发风险。
[Abstract]:Objective: to investigate the clinical characteristics of splenic cystic hydatid disease. Methods: the clinical data of 10 cases of splenic cystic hydatid disease diagnosed by surgical treatment from January 2007 to January 2016 were analyzed retrospectively. Type type hydatid disease endemic areas (Xinjiang, China, all have close contact between dogs and sheep). Of the 10 patients with SHC, 8 had a history of cystic hydatidosis one or more times. The most common initial symptom was abdominal pain in 2 patients with no traumatic surgical history, and in 10 patients, abdominal pain was the most common initial symptom. Other abdominal organs, such as abdominal distension, caused by hydatid worms, did not touch splenomegaly. Laboratory examination showed that the liver, spleen and other abdominal organs had multiple cystic space. Some visceral images showed typical cystic hydatidosis in 5 patients with splenic hydatid internal cyst excision of other parts of hydatid cyst and 4 patients with splenic multiple hydatid disease and involvement of splenic hilum with "splenectomy of other parts of hydatid picking." One case of splenic hydatid cyst was small and had a large number of calcified and necrotic signs without surgical treatment. Only "other site hydatid excision" was performed in 10 patients. After operation, albendazole was administered prophylaxis orally for 3 months to half a year. 1 cases of splenic hydatid with portal hypertension were treated with "splenectomy and other site hydatid excision". The count was maintained at the upper limit of the normal reference value and the bilateral pleural effusion occurred in 1 case with adhesive intestinal obstruction and 2 cases with bilateral pleural effusion. There were no early postoperative complications in the other 6 cases. No recurrence of splenic hydatid was found in the patients during the follow-up period of 1-3 years, and the prognosis was good. Conclusion 1. The incidence of splenic cystic hydatidosis is low, except the splenic hydatid disease. At the same time, most of the patients with secondary splenic hydatid disease had history of hydatid disease. 3. The clinical manifestations of secondary splenic cystic hydatid disease were lack of specificity, and routine serum detection had no specific significance for clinical diagnosis. The initial diagnosis can be combined with the imaging and history of typical hydatid cyst in spleen or other parts, and the diagnosis needs postoperative pathology .4.The clinical diagnosis of secondary splenic hydatid cyst is suitable for laparotomy combined with postoperative deworming treatment, which can reduce the risk of recurrence.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R532.32

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